Implementation of Positive Advanced Recovery Connections in Primary and Secondary Mental Health Care-A Registered Advanced Nurse Practitioner-Led Initiative.
A Cunningham, D De La Harpe Golden, M Pink and 7 others
PMID 39352082WHAT IT FOUND
People referred to a nurse-led mental health clinic reported lower distress, symptoms and functioning problems after assessment, CBT, Decider Skills and signposting.
Most were offered an appointment within one week; mild secondary-care cases made up 50% then 28% of caseload.
Key findings
01In the primary care dataset, overall CORE-OM distress decreased significantly after the pathway, with a mean difference of 1.16.
02Access was fast: average waiting time was 3.6 working days, and 97% of participants were offered an initial appointment within 1 week.
03The proportion of secondary-care caseload made up of mild to moderate diagnoses was reported as 50% then 28% after the pathway started.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study had no comparison group or random allocation, so changes over time could be due to many factors. It was done in one service in Ireland, with particular staff and organisational support, so it may not transfer elsewhere. Only 157 of 215 referred service users completed both pre- and post-measures, and many post-measures were missing in each dataset. There was no follow-up after the intervention ended, so durability is unknown. Waiting times could not be compared before and after PARC because existing waiting list data were aggregated across teams. Participants received assessment, CBT, Decider Skills and signposting together, so the effect of any single component cannot be separated. Data were collected during the COVID-19 pandemic, which affected participation and completed measures. Self-report on the CORE-OM may have been influenced by acquiescence bias. The pathway excluded people under 18, current inpatients, some people over 65, and referrals suggestive of severe and enduring illness, so findings do not apply to those groups.
Declared interests
The authors declared no conflicts of interest. Funding was from Mental Health Ireland, Kevin Plunkett Award.
The easy way to misread this
Do not read the significant CORE-OM reductions as proof that the nurse-led programme caused them. The study was uncontrolled, participants received assessment, CBT, Decider Skills and signposting together, and the paper could not compare waiting times before and after, so the contribution of any single component is unclear.